Provider Demographics
NPI:1669699948
Name:GIESICK, GLENNA M (PHD)
Entity type:Individual
Prefix:DR
First Name:GLENNA
Middle Name:M
Last Name:GIESICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WATER ST NE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303-6967
Mailing Address - Country:US
Mailing Address - Phone:503-363-2430
Mailing Address - Fax:503-363-2195
Practice Address - Street 1:1505 WATER ST NE
Practice Address - Street 2:SUITE 5
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97303-6967
Practice Address - Country:US
Practice Address - Phone:503-363-2430
Practice Address - Fax:503-363-2195
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1036103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling